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Billing code 64818: SympathectomyMedicare rate & RVUs

Reports operative interruption or removal of sympathetic tissue along the lumbar chain for selected lower-extremity vascular or pain conditions.

CMS RVU26DEffective Oct 1, 2026109 payment localities15 Medicare services in 2024

Medicare pays $719.12 for 64818 nationally in a facility.

Medicare rate · 64818

Sympathectomy

Swap in your local Medicare rate.

Work RVUs
11.06
Total RVUs
21.53
Global days
090

National rate · 2026

$719.12

Facility setting, before claim adjustments.

See every locality for 64818 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 64818 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 64818 covers

A lumbar sympathectomy interrupts or removes sympathetic tissue along the lumbar chain to reduce sympathetic effects on the lower extremity. It is performed by a surgeon in an operating room for selected vascular or pain conditions when this intervention is part of the treatment plan. The operative report should identify the lumbar target and the work performed; the indication and treated side should also be clear.

Report 64818 for the lumbar sympathetic target, not for sympathectomy directed at the thoracolumbar region or a distal artery. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral surgery, modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 64818 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

64818 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$651.05
Alaska*Unavailable$886.04
ArizonaUnavailable$699.37
ArkansasUnavailable$642.70
AtlantaUnavailable$740.41
AustinUnavailable$726.59
BakersfieldUnavailable$721.32
Baltimore/Surr. CntysUnavailable$763.49
BeaumontUnavailable$689.15
BrazoriaUnavailable$702.30

64818 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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Local rates. Clear comparisons.

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View every state and territory as a table
64818 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 64818 rate is calculated

Each of 64818’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 64818

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 11.06Practice expense 8.11Malpractice 2.36

21.5300 adjusted RVUs×$33.4009 conversion factor=$719.12

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 64818

64818 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 64818

Sympathectomy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.11/0.76/0.13Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 64818

Sympathectomy

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

64818 without 50 · national facility

$719.12

Sympathectomy

64818-50 · Bilateral: 150%

$1,078.68

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

64818 compared with similar codes

Compare codes

64818 vs 64809 vs 64820 vs 64821: national Medicare rates

Swap in your local Medicare rate.

  • 64818
    Sympathectomy · 11.06 wRVU
    —
  • 64809
    Sympathectomy · 14.34 wRVU
    —
  • 64820
    Sympathectomy · 10.47 wRVU
    —
  • 64821
    Arterial sympathectomy · 9.1 wRVU
    —

How to choose

64809Sympathectomy
Use 64818 for the lumbar sympathetic chain; use 64809 when the operative target is thoracolumbar.
64820Sympathectomy
64820 addresses sympathectomy at a digital artery. It is not the code for lumbar chain surgery.
64821Arterial sympathectomy
64821 identifies radial artery sympathectomy, a distal arterial target distinct from the lumbar sympathetic chain.

Codes related to 64818

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 64818
CodeHow it relatesNational office range
Same family
64809SympathectomySympathectomy directed at the thoracolumbar region rather than the lumbar chain.No office rate
64802Cervical sympathectomySympathectomy at the cervical level.No office rate
64804SympathectomySympathectomy at the cervicothoracic level.No office rate
64820SympathectomySympathectomy directed at a digital artery, not the lumbar sympathetic chain.No office rate
64821Arterial sympathectomySympathectomy directed at the radial artery.No office rate

64818 billing questions

How does 64818 differ from 64809?

64818 is for work directed at the lumbar sympathetic chain. Choose 64809 when the treated sympathetic region is thoracolumbar.

Is a distal artery sympathectomy reported with 64818?

No. Codes such as 64820 describe sympathectomy at a digital artery, rather than the lumbar chain.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How is bilateral lumbar sympathectomy reported?

For bilateral surgery, report modifier 50; CMS pays the bilateral procedure at 150%.

Can an assistant or co-surgeon be paid?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What happens when another procedure is performed in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 64818PPRRVU2026_Oct_nonQPP.csv, line 7,244 (RVU26D)

Open CMS sourceHow we calculate rates

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